This research proposal attempts to answer the following questions: 1) Can a measure of language fluency/discordance be developed to capture communication behaviors used by foreign-born IMG physicians that are predictive of patient outcomes? 2) Are there differences in the communication behaviors of foreign-born IMG physicians and USMG physicians with ethnic minority, low income, and Medicaid versus white, higher income, and privately insured patients? 3) Does language fluency discordance (defined by primary language spoken at home and/or a new measure) between physicians and patients explain racial and ethnic disparities in patient ratings of care and health status? Research methods focus on secondary data analysis of 1) audiotapes of primary care medical visits and 2) data from patient and physician questionnaires collected proximal to time of audio taping visits. Information gained from this work may help to inform the development of medical education and health care system interventions targeting physicians who are foreign-born and international medical graduates and the patient populations they serve, to improve quality of care and health outcomes for minority and low SES patients. [unreadable] [unreadable] [unreadable]